Healthcare Provider Details

I. General information

NPI: 1962892976
Provider Name (Legal Business Name): VALERIE L LYBARGER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BRYANT ST
LOUISVILLE IL
62858-1000
US

IV. Provider business mailing address

850 BRYANT ST
LOUISVILLE IL
62858-1000
US

V. Phone/Fax

Practice location:
  • Phone: 618-665-7000
  • Fax: 618-665-7010
Mailing address:
  • Phone: 618-665-7000
  • Fax: 618-665-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.012403
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: